System for vision examination utilizing telemedicine

ABSTRACT

The telemedicine method and system disclosed includes at least one remote exam module which in turn includes a plurality of optical devices configured to examine a patient&#39;s eye, and a controller for collecting and transmitting the examination data of the patient&#39;s eye. The information collected is transmitted via a communications link to a diagnostic center for analyzing the information collected at the remote exam module. The diagnostic center further maintains a database of patient records corresponding to the remotely collected examination information and an exam console for enabling a diagnosis based on the collected information.

BACKGROUND OF THE INVENTION

This application claims priority from Provisional Application Ser. No.60/272,054, filed on Mar. 1, 2001.

FIELD OF THE INVENTION

The present invention relates to systems and methods for examining apatient's vision, and more particularly, to imaging systems andcommunications systems that enable the ophthalmic diagnosis of a patientin a remote location.

DESCRIPTION OF THE PRIOR ART

A number of systems have been developed for use in medical examinations,some of which can be applied in a telemedicine context, i.e., in whichdata or results from the examination are transmitted over an electronicor other communication link and saved in a central electronic medicalrecord database so that a physician or other medical worker need not bein the same location as the patient. For example, telemedicine systemsfor performing vision testing and eye examination are described in U.S.Pat. Nos. 4,761,071; 5,617,157; 5,694,199; 5,912,720; 5,943,116;5,993,001; 6,003,991; 6,022,315; 6,027,217; and 6,033,076. Thosepatents, however, only use either a camera or a video/audio feedbackmechanism as diagnostic equipment. Thus, the patents do not disclosesystems or methods for collecting a patient's tonometry, blood pressure,anterior segment evaluation, corneal topography, refraction, etc., suchas to enable a full examination of the eye.

To avoid increasing the risk of blindness and other eye diseases,individuals should have their vision fully examined at least once ayear. Because of illness, location, time constraints or other factors,some individuals cannot readily travel to central medical facilities orother eye care facilities. Accordingly, there is a need in the art for asystem that integrates the operation of several optical devices to allowa vision examination to be conducted on a patient from a remotelocation.

SUMMARY AND OBJECTS OF THE INVENTION

The present invention provides a unique telemedicine method and systemincluding at least one remote exam module which in turn includes severaloptical devices configured to examine a patient's eye, and a controllerfor collecting information from the plurality of optical devices, aswell as for controlling the examination of the patient's eye.

The method and system of the invention further includes a diagnosticcenter for analyzing the information collected and a communications linkconnecting the diagnostic center to the remote exam module and fortransmitting the information collected from the remote exam module tothe diagnostic center. The diagnostic center may further include acentral electronic database for saving and maintaining recordscorresponding to the collected information and an exam console forenabling a diagnosis based on the collected information.

It is therefore a primary object of the present invention to provide amethod and system for examining the eyes of a patient and to enable thedetermination of the condition of the eye, as well as the diagnosis ofeye disorders and diseases at a location remote from the patient.

It is a further object of the present invention to provide the patientwith a diagnostic report and necessary prescriptions before the patientleaves the examination location.

Still further, it is another object of the present invention to achievethe foregoing objectives by enabling the communication of examinationdata collected by optical devices via a communications link capable oftransmitting high-resolution images.

With these and other objects, advantage and features of the inventionthat may become hereinafter apparent, the nature of the invention may bemore clearly understood by reference to the following detaileddescription of the invention, the claims and to the accompanyingdrawings.

BRIEF DESCRIPTION OF THE DRAWINGS

The preferred embodiments of this invention will be described in detail,with reference to the following figures, wherein:

FIG. 1 is a schematic view of one embodiment of the system of thepresent invention; and

FIG. 2 is a schematic view of one embodiment of an exam module and adiagnostic center of the present invention.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

The present invention incorporates the use of commercially availableophthalmic diagnostic equipment and software. The equipment isintegrated via hardware and software into a comprehensive telemedicineeye examination system. This system is designed to be operatedindependently by the individual who desires that his or her eyes beexamined or with the assistance of a vision care technician. This systemis generally comprised of three sub-systems, the examination site, theInternet transmission center and the diagnostic center. The examinationsite is the location wherein the patient interacts with the system forself testing using the ophthalmic diagnostic equipment, or where thetechnician administers the testing to the patient, to gather therelevant information. The examination site is generally remote from thediagnostic center, however it can be appreciated that the remoteness ofthe location may comprise the distance of a room, or may include adistance of many thousands of miles. The Internet transmission centercomprises both the hardware and software that permits the examinationsite and diagnostic center to interface and communicate with each other.The diagnostic center comprises the physical location wherein theoptometrist or ophthalmologist reviews the examination data and makesthe patient's diagnosis.

The examination software is based upon commercially available ophthalmicdiagnostic equipment and software, integrated via commercially availableand custom developed hardware and software into a comprehensive eyeexamination system which can be hosted on a standard PC. This softwaredrives the equipment that captures the eye examination data. Thecaptured data is then transmitted to a central electronic medical recorddatabase in a remote diagnostic center where it is saved as part of theexamination process. The data for a patient is displayed on anexamination console for the supervising eye care practitioner to makethe diagnosis. With respect to the present invention, an eye carepractitioner includes but is not limited to an ophthalmologist,optometrist, optician or other individual licensed to examine the eyeand use of one or another term herein is not meant to be limiting. Oncethe examination is completed, the patient receives a printed summaryreport of the examination from the exam module and may receive a printedprescription.

The main features of the present invention include:

-   -   Integration of diagnostic equipment and the data captured by the        diagnostic equipment for transmission to the diagnostic center        and subsequent validation.    -   Video conferencing system to allow visual interaction between a        patient sitting in a remote examination location and an eye care        practitioner working from the diagnostic center during an        examination.    -   Display of patient data screens that provide patient information        to the remote eye care practitioner.    -   Creation of a patient data report, which includes a summary        report of the patient's vision testing, a printed copy of which        is delivered to the patient upon completion of the examination.

Referring now to the schematic drawings, FIG. 1 shows a high-level blockdiagram of the system 100 of the present invention. The system 100includes a plurality of exam modules 101, 103, and 105; a diagnosticcenter 107; a medical record database 209 (see FIG. 2); and a computer111 for executing a diagnosis algorithm. The medical record database 209as well as the computer 111 is preferably located in the diagnosticcenter 107. The system 100 may also include a server 109 hosting a website.

With reference to FIG. 2, the diagnostic center 107 includes an examconsole 119 and a video conferencing system 117. The exam modules 101,103, and 105 are identical in function and structure so that only onewill be described herein. FIG. 2 illustrates the exam module 101, whichis also used as an example in the description that follows. Typicaldiagnostic equipment includes that which is used in normal and customaryeye examinations and may include any one or more of, but is not limitedto, the following: lensometer, tonometer, visual fields tester, funduscamera, retinal imaging systems, posterior segment imaging systems,automated refractor, biomicroscope and/or corneal topographer.

Exam module 101 is at a location (e.g., an office, room, etc.) where apatient sits to be examined. The term remote location as used herein canbe any location whereat the patient and the diagnosing eye carepractitioner are in different locations, including being in differentrooms, buildings, cities or other separation in space. At this location,which is remote from the diagnostic center 107, the patient's vision istested and the test data is collected and sent to the diagnostic center107 via a link 102, for example. As shown in FIG. 1, the data links 102,106, and 110 correspond to the exam modules 101, 103, and 105,respectively.

The teleconference system 117 may use a communications link supportingthe transmission of low-resolution images in real-time, for example inM-PEG format. The teleconference system 117 is optionally used for thereal-time communication between an eye care practitioner located at thediagnostic center 107, and either a patient undergoing examination or atechnician assisting in the examination, both of whom would bephysically present at one of the exam modules 101, 103, 105.

The exam console 119 in the diagnostic center includes a standardpersonal computer (“PC”) able to process high-resolution imagestransmitted from the exam module 101 (e.g., pictures of the eye) whichare displayed to the eye care practitioner. The high-resolution imagescorrespond to the examination data captured by ophthalmic diagnosticequipment in the exam module 101, such as a retinal camera 205, a slitlamp camera 207, and an automated refractor 211 as shown in FIG. 2. Theexam console is preferably comprised of a series of computer monitorsset up to present the data provided to the exam console by the examcontroller using commercially available hardware links between thevarious pieces of equipment as well as the video conferencing system. Inpractice, the exam console interacts with the electronic medical recordsdatabase and the system software to assimilate the data for presentationto the technician, the eye care practitioner or the patient. The examconsole may also present to the optometrist or ophthalmologist, care andtreatment suggestions from the database and textbook entries, thusassisting the optometrist or ophthalmologist in making the patient'sdiagnosis as well as providing assistance to the optometrist orophthalmologist in ways to advise the patient.

The captured data is sent to the diagnostic center 107 via acommunications link 102. Thus, in addition to supporting thetransmission of low-resolution images to the teleconferencing system 117to enhance the interpersonal aspects of the system, the datacommunications link 102 supports the transmission of high-resolutionimages to the exam console 119. The standard for transmission of datacorresponding to the high-resolution images may be dictated by theoptical device (e.g., retinal camera 205 in FIG. 2) which initiallycaptures the data. The communications link 102 provides sufficientbandwidth to transmit the data in real-time, regardless of the datatransmission protocol.

The database electronically stores all of the patient information foraccess by the patient, technician or practitioner, as appropriate, atany time via the vision care website. The database is also designed toenable collection of data from multiple patients, creation of statisticsusing the data contained therein and to analyze the data therebyallowing practitioner to search for and research population grouptrends, changes or expectations based on various criteria. The database209 is preferably hosted on a high bandwidth server that maintains alloptical records. The database may utilize commercially availablehardware and software. The records database software is designed tointerface with the custom system software. The database 209 may also beavailable for access via a web interface, such as that provided by theweb site 109. In practice, the exam console input is stored in therecords database. Data may be included or added to the records databaseby the system software based on a variety of factors. Patient recordsmay be stored and accessed from the database by the exam console ordiagnostic center and can be accessed by the technician or practitionerusing the exam controller, the exam console or vision care website, asappropriate. Patients can access the web site 109 to view their privateexamination data or prescriptions that may be stored in the database 209once they have been granted access (e.g., by a password) by a databaseadministrator. Other health professionals may also view the examinationdata on the web site so long as they are provided with proper access tothe database 209. Data encryption technology may be utilized to ensurethe safety of patient records.

The computer 111 may run, for example, software that performs advancedstatistical analysis on the collected examination data and software thatdetects pathological conditions and advises the supervising eye carepractitioner of any important issues. For example, if the patient haselevated intraocular pressures, a marginal cup/disc ratio and visualfield anomalies, an algorithm will indicate the probability of thepatient having glaucoma. In another example, if the patient is a middleaged person with variable vision and exhibits retinal cotton-woolexudates, an algorithm will indicate the probability of that personhaving diabetes.

The eye care practitioner may then use the teleconference system 117 toresolve the issues with the technician assisting in the examination atthe exam module location 101. The eye care practitioner may then reviewthe collected data as well as the results of the analysis to determinethe diagnosis and treatment and to complete an examination report. Theexamination report is then transmitted to the examination module 101 viathe communications link 104, where it can be printed for the patient'spersonal records. The links 108 and 112 perform the same functions aslink 104 but with respect to exam modules 103 and 105.

The exam module 101 may include special fixtures to allow the patient tosit in a single location and enable individual pieces of equipment to bequickly and easily moved into and out of position at the patient'slocation. This increases the patient's comfort level as well asdecreases examination time.

In addition to the cameras 205, 207, and refractor 211, the exam module101 may include other optical diagnostic equipment, such as a casehistory capture device, a lensometer, a tonometer, a visual fieldstester, a fundus camera, a biomicroscope, and a corneal topographer.

All of the foregoing optical diagnostic equipment are well known in thefield of eye vision examination. In essence, the information that may becollected by such devices includes fundus information, refractioninformation, the patient's visual acuity, neutralization of the habitualprescription, tonometry information, visual fields information, bloodpressure information, anterior segment information, corneal topographyinformation, and intraocular lens status. These devices may offer RS-232serial port, parallel printer port, USB port remote connectivity orother standard connection device. The above ports can be used toremotely control these devices, and results for diagnosis can beacquired via the ports.

The exam controller 203 may be a commercially available PC, preferablyrunning an embedded operating system, for example, embedded Windows NT.It may include external connections to simultaneously control all of theoptical diagnostic equipment in the exam module 101 as well as externalinterfaces such as voice input capabilities and touch screen input toallow the patient or technician to enter the relevant information intothe system. The exam controller 203 controls the examination process bysequentially controlling the operation of each piece of diagnosticequipment and collecting examination information from the diagnosticequipment. The software may be proprietary for example, and isprogrammed to manage the equipment interface, data flow as well as thetransport of high-resolution images and low-bandwidth video images. Theexam controller 203 provides the patient with the examination resultsvia the computer monitor.

In practice the patient or technician using the exam controller 203 willenter the requisite information into the exam controller 203 by anyconventional method, including for example, personal computer keyboard,voice input system 213 or touch screen 215. The patient may enterinformation for either creating or updating a record by answering adisplayed questionnaire. Once the information has been entered thesoftware manages the exam sequence in such a way so as to take intoaccount patient reaction, reactions by the technician if appropriate,diagnostic equipment interface, technical data entered to the system,relevant patient information, the type of exam being conducted, and anyinformation entered into the exam console or at the diagnostic center ifappropriate. The exam controller includes separate interface moduleswhich may combine to act in concert when appropriate. These interfacemodules allow the exam controller 203 to communicate with the variouspieces of equipment in a manner consistent with the protocol used byeach such piece of equipment. When in use the exam controller 203 willindicate to the technician, patient or diagnostic equipment, asappropriate, that the specific task is ready to commence. In response,the technician, patient or equipment, as appropriate will signal theequipment to proceed. Once the test has been run or the equipment hascompleted its performance, the exam controller will use its interfacemodule to collect and receive the data and transmit such to the examconsole in the diagnostic center for review by the ophthalmologist oroptometrist. Both the exam controller and the exam console are capableof managing and controlling the transmission of information between thetwo systems. The exam controller may also enable video conferencingbetween the patient and/or technician and the optometrist orophthalmologist located at the diagnostic center location.

It may be appreciated that biometrics may be utilized for examinitiation to ensure the patient ID and record match the patient. Theexam controller 203 either creates or locates the patient record andcreates an examination record in the database 209. The data may be sentto the database 209 via communications link 102 (FIG. 1). The links 104and 102 may be implemented as an Internet connection or remote link 202(FIG. 2).

The exam controller 203 may also support a low-resolutionvideo-conference camera incorporated in the teleconference system 217.

When an exam is started, the examination data for that patient isbrought up on the console. As the technician (or the patient)administers the data collection, the data is transferred to the examconsole 107 and the eye care professional reviews the data and creates areport. After the report is created, it is transmitted to the examcontroller 203 where the results are printed out for the patient.

The remote link or Internet connection 202 facilitates two-waycommunication between the exam controller and the exam console in thediagnostic center. The hardware utilized to create the remote link iscommercially available and includes, router, hubs, ports and othersimilar equipment typically found in an electronic communication center.The remote link may also be capable of utilizing commercially availabledata, as well as voice and/or video communication software. In practice,the preferred connection for the remote link is one having ahigh-bandwidth, however, dial-up connection or a wireless connection maybe used, however, for video conferencing a minimum of ISDL isrecommended.

Encryption and decryption of all patient data ensures that the operatorsof the system 100 maintains control and confidentiality in all aspectsof patient care and communication. The encryption may be applied to databefore transmission through any of the communication links or beforestorage in the database 209.

The system 100 utilizes several software components. For example, theexam controller software is a piece of software hosted by embeddedWindows NT. This software may include interface modules, which allow itto communicate with the many variations of ophthalmic diagnosticequipment on the market. Each piece of equipment may have its ownprivate protocol, which must be observed. This software ensurescompatibility with the major vendors of optical diagnostic equipment.The exam controller software may include a core component to manage theflow of data from the exam process performed in an examination module tothe database 209 and the exam console 107. The data may include textualdata, high-resolution images and low bandwidth video-conferencingtransmissions. The exam controller 203 may include a local interfacethat is used by the technician to execute the examination.

The database 209 may be a commercially available database running on acommercially available 24/7-uptime server. This server is preferablybacked up and may be redundant.

The web site 109 provides a web front end to the database 209 and acorporate web presence. The website permits patients to access their ownpersonal records via an Internet connection, including access to theirvision wear prescription and the ability to transmit their personalinformation to a qualified eye care professional for purchase ofprescription eye wear. The patient may also utilize the website toprovide other eye care professionals with access to his or her ownmedical records and eye exam/care history. The website may also serve asan information center which includes links to other informationalwebsites and ocular business sites. The website will utilize standardinput and functionality screens and can be accessed in the normal courseof Internet and World Wide Web browsing. Software utilized in theoperation of a web site is well known in the art and therefore need notbe described in detail herein.

The exam console software may be a custom piece hosted by WindowsNT/2000 or EP. This software is designed to manage all interface betweenthe various commercially available hardware and software contained inthis vision care system including each of the hardware and softwareplatforms. This software must be designed to integrate the diagnosticequipment and the data transmission to a remote site as well as validatethe data transmitted in such transmission, manage video conferencing,develop a central diagnostic center for practitioners to evaluate thepatient's data, design patient data screens to provide information tothe remote practitioner, develop a patient report, manage and conductthe remote eye exam. This software may graphically display thecomponents of the eye examination, manage video-conferencing, and handlesubmission of the examination data to the database 209 and the examcontroller 203.

While this invention has been described in conjunction with the specificembodiments outlined above, it is evident that many alternatives,modifications and variations are apparent to those skilled in the art.Accordingly, the preferred embodiments of the invention as set forthabove are intended to be illustrative and not limiting. Various changesmay be made without departing from the spirit and scope of theinvention.

1. A method of conducting a comprehensive eye examination from a remotelocation, comprising examining an eye of a patient at an eye examinationlocation using a plurality of eye examination devices at the eyeexamination location to provide eye examination data; transmitting theeye examination data to a diagnostic center remotely located from theeye examination location to enable the diagnosis of an eye disorder ordisease of the patient by a licensed eye care practitioner located atthe diagnostic center, the diagnostic center including no eyeexamination devices; and providing a diagnosis and a prescription, basedon the eye examination data, to the patient via a communications linkbefore the patient leaves the eye examination location.
 2. The method ofclaim 1, further comprising: displaying images corresponding to thetransmitted eye examination data; and diagnosing ophthalmic conditionsof the patient by examining the images.
 3. The method of claim 2,wherein displaying the images comprises displaying the images insubstantially real-time.
 4. The method of claim 1, wherein the diagnosisis obtained by analyzing the transmitted eye examination data.
 5. Themethod of claim 4, wherein the analyzing is performed using at least onecomputer.
 6. The method of claim 1, wherein the diagnostic centercomprises a database, and the method further comprises updating thepatient's health and visual history information to the database afterthe patient is tested and the diagnosis is provided.
 7. The method ofclaim 6, further comprising providing access to records in the databasevia a web interface.
 8. The method of claim 1, wherein the diagnosis isprovided as a report to the patient.
 9. The method of claim 1, furthercomprising exchanging real-time video using a video conferencing system.10. The method of claim 1, wherein the eye examination data istransmitted through a world wide web interface.
 11. The method of claim1, wherein the eye examination data comprises at least one type ofinformation selected from the group consisting of information providedby the patient; fundus information; posterior segment information;refraction information; neutralization of the habitual description;tonometry information; visual fields information; blood pressureinformation; anterior segment information; corneal topography; retinalinformation; intraocular lens status, and combinations thereof.
 12. Themethod of claim 1, further comprising establishing a substantiallyreal-time interactive communication link between the eye carepractitioner located at the diagnostic center and the patient located atthe eye examination location.
 13. The method of claim 1, wherein thetransmitted data comprises information provided by the patient, andobjective information obtained from examination of the patient's eye.14. The method of claim 1, further comprising displaying a questionnaireto the patient for collection of patient history data, the questionnairebeing displayed on a display unit.
 15. The method of claim 14, whereinthe display unit comprises a touch-screen, and the method furthercomprises receiving information about the patient entered using thetouch-screen.
 16. The method of claim 15, further comprising receivingverbal responses to the questionnaire using a voice activated inputunit.
 17. The method of claim 15, further comprising providing access ofthe patient's case history to the patient located at the eye examinationlocation via an Internet web site.
 18. The method of claim 1 in whichthe eye examination devices comprise at least three devices selectedfrom the group consisting of lensometer, a tonometer, a visual fieldtester, a fundus camera, a retinal imaging system, a posterior segmentimagine system, an automated refractor, a biomicroscope, and a cornealtopographer.